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Urinary bladder cancer is the second most common tumour disease after lung cancer leading to death in people with a spinal cord injury. This paper provides a comprehensive overview of the differences relevant to urologists between urinary bladder tumours in this population compared with urinary bladder tumours in the general population.People with a spinal cord injury are 1 to 2 decades younger on average at the time of tumour diagnosis than patients without a spinal cord injury. Histopathologic findings at the initial diagnosis of urinary bladder cancer in people with a spinal cord injury are much less favourable than for urinary bladder cancers in the general population. Muscle-invasive tumours and tumours with poor differentiation are much more common, and the proportion of squamous cell carcinomas is significantly higher. The incidence rises after more than 10 years of paralysis. Urinary bladder cancer mortality is significantly elevated and increases with the duration of paralysis. In diagnostic procedures and, in particular, in radical cystectomy, clinically important features have to be considered. For example, urodynamic examinations or cystoscopy may trigger autonomic dysreflexia with hypertensive crises and the risk of life-threatening bradycardia.In the case of radical cystectomy, frequent adhesions and callosities of the urinary bladder, among other things, must be taken into account intraoperatively. Severe paralysis, prolonged intestinal atony and other conditions are frequently observed after the surgical procedure due to neurogenic bowel dysfunction. Correct positioning of the patient immediately after surgery to avoid decubitus and to support breathing, as well as bowel management specific to spinal cord injury, must be strictly observed.Other special features of paraplegic patients with urinary bladder cancer that should also be considered in clinical practice, as well as considerations for screening for urinary bladder tumors, are presented in the article.Das Harnblasenkarzinom ist, nach dem Lungenkrebs, bei Querschnittgelähmten die zweithäufigste zum Tode führende Tumorerkrankung. Die vorliegende Arbeit gibt einen umfassenden Überblick über die für den Urologen wichtigen Unterschiede im Vergleich zu Harnblasentumoren in der Allgemeinbevölkerung.Querschnittgelähmte sind zum Zeitpunkt der Tumordiagnose im Durchschnitt 1 bis 2 Jahrzehnte jünger als Patienten ohne Querschnittlähmung. Der histopathologische Befund bei Erstdiagnose eines Harnblasenkarzinoms bei Menschen mit Querschnittlähmung ist wesentlich ungünstiger als bei Harnblasenkarzinomen in der Allgemeinbevölkerung. Muskelinvasive Tumoren und Tumoren mit geringer Differenzierung sind wesentlich häufiger und der Anteil an Plattenepithelkarzinomen ist deutlich erhöht. Die Häufigkeit nimmt nach über 10 Lähmungsjahren zu. Die Harnblasenkarzinom-Mortalität ist deutlich erhöht und steigt mit zunehmender Lähmungsdauer an.Bei diagnostischen Eingriffen und insbesondere bei der radikalen Zystektomie sind klinisch wichtige Besonderheiten zu beachten. So können z. B. urodynamische Untersuchungen oder eine Zystoskopie eine Autonome Dysreflexie mit hypertensiven Krisen und der Gefahr einer lebensbedrohlichen Bradykardie triggern. Bei einer radikalen Zystektomie sind intraoperativ u.a. die häufig auftretenden Verwachsungen und Verschwielungen der Harnblase zu beachten. Postoperativ treten u.a. häufig, bedingt durch die neurogene Störung des Darmes, schwere Paralysen und prolongierte Darmatonien auf. Die unmittelbar nach der Operation vorzunehmende Lagerung der Patienten zur Vermeidung von Dekubiti und zur Unterstützung der Atmung sowie das Querschnittgelähmten-spezifische Darmmanagement sind unbedingt zu beachten. Weitere Besonderheiten bei querschnittgelähmten Patienten mit Harnblasenkarzinom, die auch in der klinischen Praxis Beachtung finden sollten, sowie Überlegungen zum Screening nach Harnblasentumoren werden im Beitrag dargestellt.

In men who wish to have children after a spinal cord injury, assisted ejaculation is frequently needed for sperm retrieval. Transrectal electrostimulation (TES) is often used for this purpose. Typical side effects of TES are autonomic dysreflexia or pain. In a 33-year old man with complete tetraplegia below C6 since 2004, TES caused massive leg spasticity, leading to transcervical fracture of the femoral neck. This previously unreported complication of TES demonstrates that, in men with long-term chronic tetraplegia, spasticity and osteoporosis, TES in anesthesia should be taken into consideration.Bei Männern mit Kinderwunsch nach Rückenmarkverletzung ist häufig eine assistierte Ejakulation zur Gewinnung von Sperma erforderlich. Hierzu wird häufig die transrektale Elektrostimulation (TES) eingesetzt. Typische unerwünschte Effekte der TES sind autonome Dysregulation und Schmerzen. Bei einem 33-jährigen Mann mit kompletter Tetraplegie sub C6 seit 2004 kam es unter TES zu einer derart starken Beugespastik der Beine, dass eine transzervikale Schenkelhalsfraktur resultierte. Diese bisher nicht beschriebene Komplikation der TES zeigt, dass bei Männern mit langjähriger Tetraplegie, Spastizität und Osteoporose die Durchführung der TES in Narkose in Erwägung gezogen werden sollte.

Spinal cord injuries (SCI) are serious medical conditions, which are associated with severe and potentially fatal risks and complications depending on the location and extent of injury. Traffic accidents, falls and recreational activities are the leading causes for traumatic SCI (TSCI) worldwide whereas non-traumatic spinal cord injuries (NTSCI) are mostly due to tumors and congenital diseases. As chronification of the injuries progresses other organ systems are affected including anatomical changes, the respiratory and cardiovascular systems and endocrinological pathways. All these effects have to be considered in the anesthesiological management of patients with SCI. Autonomic dysreflexia (AD) is the most dangerous and life-threatening complication in patients with chronic SCI above T6 that results from an overstimulation of sympathetic reflex circuits in the upper thoracic spine and can be fatal. This article summarizes the specific pathophysiology of SCI and how AD can be avoided as well as also providing anesthetists with strategies for perioperative and intensive care management of patients with SCI.

Nearly all men with spinal cord injury suffer from neurogenic sexual dysfunction which is often treated with phosphodiesterase-5 (PDE5) inhibitors. We describe a case of subarachnoid hemorrhage due to autonomic dysreflexia (AD) caused by sexual stimulation. Nitrates are frequently used for acute treatment of AD; however, the use of these drugs in combination with PDE5 inhibitors is contraindicated. Therefore, meticulous information from patients and relatives on the risk of AD and possible drug interactions is of vital importance.

In-hospital rehabilitation of para-/tetraplegic patients is followed by the family doctor's long-term surveillance supported by annual checkups in the rehabilitation clinic. The family doctor bears a heavy burden of responsibility. Loss of sensation may cover a wide range of complications. Most of these functional disorders are the consequence of reduced physical activity and a disturbed autonomic nervous system. There is a significantly high incidence of pulmonary infection, in particular pneumonia and atelectasis, coronary heart disease, autonomic dysreflexia, urinary tract infections, kidney stones, renal and hepatic insufficiency, gallstones, constipation and ileus, as well as decubitus, osteoporosis and so on. Chronic severe pain and spasm also require optimum therapy, in view of their potential to reduce quality of life and working capacity. This article provides an overview of several relevant problems in internal medicine involving diagnosis, therapy and long-tem surveillance of patients with spinal cord injuries.

While the consequences of damage to the sensorimotor nervous system in spinal cord injury are obvious, autonomic dysreflexia often goes unrecognised. Spinal cord injury affecting the cord above the fifth thoracic segment involves interruption of the connection between brain and sympathetic nervous system and, below the level of the lesion, the sacral parasympathetic nervous system. The isolated spinal cord continues to function, except for the directly damaged segment, but there is no central control. The autonomic nervous system below the level of the lesion can trigger severe reactions from the cardiovascular system which diminish quality of life and even promote severe morbidity. Autonomous malfunction can also have clinical effects in relation to thermoregulation and gastrointestinal, genital and urinary tract function.